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I
got the following from healthreform.kff.org/timeline.aspx I am really
interested in learning what I can regarding what Republicans, Conservatives, Right Wingers, Tea Partiers, etc., have
against any of the changes below, if they do, and if so what do they
suggest in place of specific changes. I am not here to argue, just to
learn and the only comments, if any, I will make will be in the form of
questions.
I'd like to thank you in advance for responding.
Provisions by Year
Review of Health Plan Premium Increases
Requires
the federal government to create a process, in conjunction with states,
where insurers have to justify unreasonable premium increases. Provides
grants to states for reviewing premium increases.
Implementation : Plan year 2010
Changes in Medicare Provider Rates
Reduces
annual market basket updates for inpatient and outpatient hospital
services, long-term care hospitals, inpatient rehabilitation facilities,
and psychiatric hospitals and units and adjusts payments for
productivity.
Implementation: Beginning fiscal year 2010; productivity adjustments added to market basket update in 2012
Medicaid and CHIP Payment Advisory Commission
Provides
funding for and expands the role of the Medicaid and CHIP Payment and
Access Commission to include assessments of adult services in Medicaid.
Implementation: Funding appropriated for fiscal year 2010
Comparative Effectiveness Research
Establishes
a non-profit Patient-Centered Outcomes Research Institute to conduct
research that compares the clinical effectiveness of medical treatments.
Implementation: Funding appropriated beginning fiscal year 2010
Prevention and Public Health Fund
Appropriates
$5 billion for fiscal years 2010 through 2014 and $2 billion for each
subsequent fiscal year to support prevention and public health programs.
Implementation: Funding appropriated beginning fiscal year 2010-
Medicare Beneficiary Drug Rebate
Provides
a $250 rebate to Medicare beneficiaries who reach the Part D coverage
gap in 2010. Further subsidies and discounts that ultimately close the
coverage gap begin in 2011.
Implementation: January 1, 2010 
Small Business Tax Credits
Provides
tax credits to small employers with no more than 25 employees and
average annual wages of less than $50,000 that provide health insurance
for employees. Phase I (2010-2013): tax credit up to 35% (25% for
non-profits) of employer cost; Phase II (2014 and later): tax credit up
to 50% (35% for non-profits) of employer cost if purchased through an
insurance Exchange for two years.
Implementation: January 1, 2010- Medicaid Drug Rebate
Increases
the Medicaid drug rebate percentage for brand name drugs to 23.1%
(except the rebate for clotting factors and drugs approved exclusively
for pediatric use increases to 17.1%) and to 13% of average manufacturer
price for non-innovator, multiple source drugs. Extends the drug rebate
to Medicaid managed care plans.
Implementation: January 1,
2010 for increase in Medicaid drug rebate percentage; March 23, 2010
for extension of drug rebate to Medicaid managed care plans - Coordinating Care for Dual Eligibles
Establishes
the Federal Coordinated Health Care Office to improve care coordination
for dual eligibles (people eligible for both Medicare and Medicaid).
Implementation: March 1, 2010 - Generic Biologic Drugs
Authorizes
the Food and Drug Administration to approve generic versions of
biologic drugs and grant biologics manufacturers 12 years of exclusive
use before generics can be developed.
Implementation: March 23, 2010 
New Requirements on Non-profit Hospitals
Imposes
additional requirements on non-profit hospitals to conduct community
needs assessments and develop a financial assistance policy and impose a
tax of $50,000 per year for failure to meet these requirements.
Implementation: March 23, 2010- Medicaid Coverage for Childless Adults
Creates
a state option to provide Medicaid coverage to childless adults with
incomes up to 133% of the federal poverty level. (States will be
required to provide this coverage in 2014.)
Implementation: April 1, 2010 - Reinsurance Program for Retiree Coverage
Creates
a temporary reinsurance program for employers providing health
insurance coverage to retirees over age 55 who are not eligible for
Medicare.
Implementation: 90 days following enactment until January 1, 2014 - Pre-existing Condition Insurance Plan
Creates
a temporary program to provide health coverage to individuals with
pre-existing medical conditions who have been uninsured for at least six
months. The plan will be operated by the states or the federal
government.
Implementation: Enrollment into the federal plan began July 1, 2010; implementation dates for the state-operated plans vary - New Prevention Council
Creates
the National Prevention, Health Promotion and Public Health Council to
develop a national prevention, health promotion and public health
strategy.
Implementation : First report due July 1, 2010 - Consumer Website
Requires
the Department of Health and Human Services to develop an internet
website to help residents identify health coverage options.
Implementation : July 1, 2010 - Tax on Indoor Tanning Services
Imposes a tax of 10% on the amount paid for indoor tanning services.
Implementation : July 1, 2010 - Expansion of Drug Discount Program
Expands
eligibility for the 340(B) drug discount program to sole-community
hospitals, critical access hospitals, certain children’s hospitals, and
other entities.
Implementation: Applications accepted beginning August 2, 2010 - Adult Dependent Coverage to Age 26
Extends dependent coverage for adult children up to age 26 for all individual and group policies.
Implementation : Plan or policy years beginning on or after September 23, 2010 - Consumer Protections in Insurance
Prohibits
individual and group health plans from placing lifetime limits on the
dollar value of coverage, rescinding coverage except in cases of fraud,
and from denying children coverage based on pre-existing medical
conditions or from including pre-existing condition exclusions for
children. Restricts annual limits on the dollar value of coverage (and
eliminates annual limits in 2014)
Implementation : Plan or policy years beginning on or after September 23, 2010 (annual limits eliminated in 2014) - Insurance Plan Appeals Process
Requires
new health plans to implement an effective process for allowing
consumers to appeal health plan decisions and requires new plans to
establish an external review process.
Implementation : Plan or policy years beginning on or after September 23, 2010 - Coverage of Preventive Benefits
Requires
new health plans to provide at a minimum coverage without cost-sharing
for preventive services rated A or B by the U.S. Preventive Services
Task Force, recommended immunizations, preventive care for infants,
children, and adolescents, and additional preventive care and screenings
for women.
Implementation : Plan or policy years beginning on or after September 23, 2010 
Health Centers and the National Health Service Corps
Permanently
authorizes the federally qualified health centers and NHSC programs and
increases funding for FQHCs and for the NHSC for fiscal years
2010-2015.
Implementation: Funding appropriated beginning fiscal year 2010- Health Care Workforce Commission
Establishes
the National Health Care Workforce Commission to coordinate federal
workforce activities and make recommendations on workforce goals and
policies and establishes the National Center for Health Workforce
Analysis to undertake state and regional workforce data collection and
analysis.
Implementation : Initial appointments to the National Health Care Workforce made by September 30, 2010 - Medicaid Community-Based Services
Provides
states with new options for offering home and community-based services
through a Medicaid state plan amendment to certain individuals and
permits states to extend full Medicaid benefits to individuals receiving
home and community-based services under a state plan.
Implementation : October 1, 2010
2011(21)
- Minimum Medical Loss Ratio for Insurers
Requires
health plans to report the proportion of premium dollars spent on
clinical services, quality, and other costs and provide rebates to
consumers if the share of the premium spent on clinical services and
quality is less than 85% for plans in the large group market and 80% for
plans in the individual and small group markets.
Implementation : Requirement to report medical loss ratio effective for 2010;
requirement to provide rebates effective beginningJanuary 1, 2011 - Closing the Medicare Drug Coverage Gap
Requires
pharmaceutical manufacturers to provide a 50% discount on brand-name
prescriptions filled in the Medicare Part D coverage gap beginning in
2011 and begins phasing-in federal subsidies for generic prescriptions
filled in the Medicare Part D coverage gap.
Implementation: January 1, 2011 - Medicare Payments for Primary Care
Provides
a 10% Medicare bonus payment for primary care services; also, provides a
10% Medicare bonus payment to general surgeons practicing in health
professional shortage areas.
Implementation: January 1, 2011 through December 31, 2015 - Medicare Prevention Benefits
Eliminates
cost-sharing for Medicare-covered preventive services that are
recommended (rated A or B) by the U.S. Preventive Services Task Force
and waives the Medicare deductible for colorectal cancer screening
tests; authorizes Medicare coverage for a personalized prevention plan,
including a comprehensive health risk assessment.
Implementation: January 1, 2011 - Center for Medicare and Medicaid Innovation
Creates
the Center for Medicare and Medicaid Innovation to test new payment and
delivery system models that reduce costs while maintaining or improving
quality.
Implementation: Center established by January 1, 2011 - Medicare Premiums for Higher-Income Beneficiaries
Freezes
the income threshold for income-related Medicare Part B premiums for
2011 through 2019 at 2010 levels resulting in more people paying
income-related premiums, and reduces the Medicare Part D premium subsidy
for those with incomes above $85,000/individual and $170,000/couple.
Implementation: January 1, 2011 - Medicare Advantage Payment Changes
Restructures
payments to private Medicare Advantage plans by phasing-in payments set
at increasingly smaller percentages of Medicare fee-for-service rates;
freezes 2011 payments at 2010 levels; and prohibits Medicare Advantage
plans from imposing higher cost-sharing requirements for some Medicare
covered benefits than is required under the traditional fee-for-service
program.
Implementation: January 1, 2011 - Medicaid Health Homes
Creates
a new Medicaid state option to permit certain Medicaid enrollees to
designate a provider as a health home and provides states taking up the
option with 90% federal matching payments for two years for health
home-related services.
Implementation: January 1, 2011 - Chronic Disease Prevention in Medicaid
Provides
3-year grants to states to develop programs to provide Medicaid
enrollees with incentives to participate in comprehensive health
lifestyle programs and meet certain health behavior targets.
Implementation: January 1, 2011 
CLASS Program
Establishes
a national, voluntary insurance program for purchasing community living
assistance services and supports (CLASS program).
Implementation: January 1, 2011- National Quality Strategy
Requires
the Secretary of the federal Department of Health and Human Services to
develop and update annually a national quality improvement strategy
that includes priorities to improve the delivery of health care
services, patient health outcomes, and population health.
Implementation: Initial strategy due to Congress by January 1, 2011 - Changes to Tax-Free Savings Accounts
Excludes
the costs for over-the-counter drugs not prescribed by a doctor from
being reimbursed through a Health Reimbursement Account or health
Flexible Spending Account and from being reimbursed on a tax-free basis
through a Health Savings Account or Archer Medical Savings Account.
Increases the tax on distributions from a health savings account or an
Archer MSA that are not used for qualified medical expenses to 20% of
the amount used.
Implementation: January 1, 2011 - Grants to Establish Wellness Programs
Provides grants for up to five years to small employers that establish wellness programs.
Implementation: Funding authorized beginning in fiscal year 2011 - Teaching Health Centers
Establishes
Teaching Health Centers and provides payments for primary care
residency programs in community-based ambulatory patient care centers.
Implementation: Funding appropriated for five years beginning in fiscal year 2011 
Medical Malpractice Grants
Authorizes
$50 million for five-year demonstration grants to states to develop,
implement, and evaluate alternatives to current tort litigations.
Implementation: Authorizes funding beginning fiscal year 2011- Funding for Health Insurance Exchanges
Provides
grants to states to begin planning for the establishment of American
Health Benefit Exchanges and Small Business Health Options Program
Exchanges, which facilitate the purchase of insurance by individuals and
small employers.
Implementation: Grants awarded starting March 23, 2011; enrollment in Exchanges begins January 1, 2014 - Nutritional Labeling
Requires disclosure of the nutritional content of standard menu items at chain restaurants and food sold from vending machines.
Implementation: By March 23, 2011 - Medicaid Payments for Hospital-Acquired Infections
Prohibits federal payments to states for Medicaid services related to certain hospital-acquired infections.
Implementation: July 1, 2011 - Graduate Medical Education
Increases
the number of Graduate Medical Education (GME) training positions by
redistributing currently unused slots and promotes training in
outpatient settings.
Implementation: July 1, 2011 - Medicare Independent Payment Advisory Board
Establishes
an Independent Advisory Board, comprised of 15 members, to submit
legislative proposals containing recommendations to reduce the per
capita rate of growth in Medicare spending if spending exceeds targeted
growth rates.
Implementation: Funding available October 1, 2011; first recommendations due January 15, 2014 - Medicaid Long-Term Care Services
Creates
the State Balancing Incentive Program in Medicaid to provide enhanced
federal matching payments to increase non-institutionally based
long-term care services and establishes the Community First Choice
Option in Medicaid to provide community-based attendant support services
to certain people with disabilities.
Implementation: October 1, 2011
